IMPORTANT NOTE: Due to limited resources the last update of CalQualityCare.org occurred at the end of 2016.If you are seeking current information about long term care providers, while not as comprehensive as CalQualityCare.org, please consider the following links:

We are actively pursuing funding and hope that CalQualityCare.org will be updated in the near future and continue its mission for providing information about long term care services and supports from a trusted and easily accessible source to California’s large and rapidly growing population of aged and disabled individuals and the over 2 million users of long term services and supports.

Magnolia Gardens Convalescent Hospital

Magnolia Gardens Convalescent Hospital in Granada Hills, California 91344 has an Overall Rating of Below Average and a Staffing Rating of Below Average. See ratings on health care quality in nursing homes, why quality matters to you, and how you can help get the care you deserve.

Free and easy-to-use, CalQualityCare.org offers unbiased information and ratings on the quality of California nursing homes and skilled nursing facilities (SNF), along with tips and checklists about how to choose a facility, questions to ask, how to pay for care, and what to do if something goes wrong.

Why be concerned about quality? Even common tasks can go wrong in a facility. When you pay attention to quality, you can better protect yourself. What is quality? Quality care is not always more expensive care, the newest technology, or many tests and treatments. Quality care is safe, effective, patient centered, timely, efficient, and equitable. How does quality affect you? Hear about patients’ experiences where better care would have made a difference. Get the quality you deserve. Take steps to make sure you choose the best facility for you.

When choosing a California nursing home or skilled nursing facility, be sure to understand your particular treatment and the roles that staff play in your care; check your insurance coverage and out of pocket costs; and consider the facility’s location and other features and services.

Tools & Resources: Long Term Care

Overall Rating

NA

US Government Rating

NA

Campaign for Excellence

No

NA

US Government Watch List

No

NA

Accreditation

None

NA

Summary

Overall Rating (Data Source: CMS NH COMPARE, CA OSHPD FIN 06/22/2016)

CalQualityCare.org provides “Performance Ratings” on important measures of long term care quality. Ratings will help users assess the quality of care available and serve as a guide when comparing and choosing care providers. The Performance Ratings are: Superior, Above Average, Average, Below Average, and Poor.

CalQualityCare.org gives Performance Ratings to nursing homes in four areas: Overall, Staffing, Quality of Facility, and Quality of Care.

The Overall Performance Rating for nursing homes is based on combining the ratings for Quality of Facility, Staffing, and Quality of Care giving priority to the Facility Quality rating.

US Government Rating (Data Source: CMS NH COMPARE 06/22/2016)

The US Centers for Medicare & Medicaid Services (CMS) created a five-star quality rating system to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions. Nursing homes with five stars are considered to have above average quality, and nursing homes with one star are considered to have below average quality. For more information, see the CMS website.

The Performance Ratings provided by CalQualityCare.org include California-specific information that is not included in the CMS rating — specifically, state citations, complaints, and incidents; more comprehensive staffing information; and staff turnover rates.

Campaign for Excellence (Data Source: CFE website 02/22/2013)

Some nursing homes have volunteered to participate in the Advancing Excellence in America’s Nursing Homes campaign to improve the quality of life for residents and staff in nursing homes. The campaign’s coalition includes long term care providers, caregivers, medical and quality improvement experts, consumers, government agencies, and other quality-focused organizations.

The campaign monitors key indicators of nursing home quality, both clinical and organizational improvement goals; promotes excellence in caregiving; acknowledges the critical role nursing home staff have in providing care; and recognizes the important role of consumers to the success of the campaign by contributing ideas and suggestions.

US Government Watch List (Data Source: CMS NH COMPARE 06/22/2016)

If the page shows “yes,” then this facility has a history of serious quality issues and has been designated a “Special Focus Facility.” The US Centers for Medicare & Medicaid Services (CMS) created the Special Focus Facility (SFF) initiative to stimulate improvements in quality of care. CMS has found that a small number of nursing homes have more problems than other nursing homes; more serious problems than most other nursing homes (including harm or injury experienced by residents); and a pattern of serious problems that has persisted over a long period of time (as measured over the three years before the date the nursing home was first put on the SFF list).

CMS requires that SFF nursing homes be visited in person by survey teams twice as frequently as other nursing homes. The longer the problems persist, the more stringent the enforcement actions that will be taken.

Accreditation (Data Source: JCAHO & CARF 07/11/2016)

Accreditation is an acknowledgement that a facility meets the standards of care set by an outside organization. After a facility is accredited, it is monitored by the accrediting organization to make sure it continues to meet the standards.

Facilities are not required to be accredited, but having accreditation may indicate a commitment to providing high-quality care. However, obtaining accreditation can be expensive, which may prevent some facilities from pursuing it.

Long term care accreditation from The Joint Commission (formerly JCAHO) requires an on-site survey of the facility by a Joint Commission team. The accreditation process determines if the facility meets the Joint Commission performance standards for patient care, staffing, and management. For details on TJC accreditation, see www.jointcommission.org.

Facilities may also receive accreditation from CARF, the Commission on Accreditation of Rehabilitation Facilities, a nonprofit organization that accredits providers of rehabilitation care. For details on CARF accreditation, see www.carf.org.

Facility Characteristics

Facility Type (Data Source: ELMS 07/01/2016)

Each nursing facility is categorized as either “hospital,” which is based in a wing or department of a hospital, or “freestanding,” which means it operates independently of a hospital.

Payments Accepted (Data Source: CMS NH COMPARE 06/22/2016)

All nursing facilities in California accept payment directly from individuals. In addition, some are certified to accept payment from the Medicare program, which can pay for up to the first 100 days of care. And some facilities accept payment from the Medi-Cal program, which generally covers care for those who have low incomes and few assets. Private pay includes both private insurance and self pay.

Number of Beds (Data Source: CA OSHPD FIN 08/12/2016)

The number of skilled nursing beds at this facility licensed by the Licensing and Certification Division of the California Department of Public Health.

Occupancy Rate (Data Source: CA OSHPD FIN 08/12/2016)

The page shows the percentage of beds in use by residents on the day the facility completed its most recent cost report for the California Office of Statewide Health Planning and Development (OSHPD). The rate is the number of residents living in the facility on that day divided by the total number of licensed beds.

Types of Care Available (Data Source: CA OSHPD UTIL 08/08/2016)

The page shows the various types of care the nursing facility provides — especially important in selecting a facility that meets the medical and nursing needs of an individual.

Intermediate care: Provides less-intensive nursing care than skilled nursing facilities (SNF). Intermediate care facilities (ICF) offer dietary, pharmacy, personal care, and social and activity services, and they are required to have a licensed nurse on duty eight hours per day. People entering an ICF need occasional, but not continuous, nursing care.

Psychiatric care: More than half of the residents have behavioral health care needs. Residents in these facilities are not eligible for Medi-Cal coverage.

Residential care: The facility does not provide medical or nursing care. Services offered might include supportive care services and supervision for those who are physically or mentally impaired. Generally included are room and board, assistance with personal care and transportation, and guidance and training to help the resident maintain the ability to perform activities of daily living. Residential care facilities can be foster care, family homes, group homes, assisted living, or other types of facilities.

Subacute care: More intense care than skilled nursing care but less intense than acute hospital care. It involves intensive nursing and supportive and therapeutic care provided by licensed nurses for residents with fragile medical conditions.

HIV/AIDS program: A facility must be certified to treat patients diagnosed with Acquired Immune Deficiency Syndrome (AIDS) or HIV-related diseases. An AIDS diagnosis occurs when a person is infected with Human Immunodeficiency Virus (HIV) and he or she has also developed a specific related condition such as tuberculosis, toxoplasmosis, Kaposi sarcoma, or dementia. People who do not have one of these diseases, but whose immune system is shown by a laboratory test to be severely damaged (CD4 count of 200 cells/mm or below) also are diagnosed with AIDS.

Alzheimer’s program: A facility must be certified to treat patients diagnosed with Alzheimer’s disease. Alzheimer’s is a progressive brain disorder that gradually destroys a person’s memory and ability to learn, reason, make judgments, communicate, and carry out daily activities.

Hospice program: A facility must be certified to provide hospice care to a patient. In hospice, the focus is on making the client as comfortable as possible by providing pain management and counseling services for patients and their families.

Rehabilitation special unit: A facility must be licensed to provide intensive rehabilitation services, which are designed to make a patient as independent as possible after an illness or injury, such as physical and occupational therapy.

Ventilator beds: A facility must be licensed to operate ventilators or respirators, which are machines that mechanically assist patients in breathing and are sometimes referred to as artificial respiration.

Continuing care retirement community: In addition to nursing home care these facilities provide of a continuum of services, including independent living services, and assisted living services on a single campus. Residents can move between independent living, assisted living and nursing home care based on changing needs at each point in time. Residents entering CCRCs sign a contract that provides for housing, services and nursing care.

Race and Ethnicity

Need for Assistance

Special Care Needs

Rehabilitation

41%

27%

Extensive, Special Care, or Complex

28%

32%

Impaired Cognition

0%

5%

Behavioral Problems

0%

2%

Reduced Physical Function

31%

34%

Residents

Age (Data Source: CA OSHPD UTIL 08/08/2016)

The page shows the percentage of residents in each age group on the day the facility completed its most recent cost report. Nursing home residents typically like to be surrounded by those of an age and stage similar to their own.

Gender (Data Source: CA OSHPD UTIL 08/08/2016)

The page shows the percentage of male and female residents as reported on the day the facility completed its most recent cost report. In California, as across the nation, women generally have longer lifespans than men and therefore make up a majority of the population in nursing facilities.

Race and Ethnicity (Data Source: CA OSHPD UTIL 08/08/2016)

The page shows the percentage of residents for different racial groups and ethnicity on the day the facility completed its most recent cost report. Some nursing home residents gravitate toward facilities that house people with a race or ethnicity similar to their own. Residents are categorized into one of four races or “Other Race.” In addition, residents may be categorized as Hispanic Ethnicity.

Need for Assistance (Data Source: CASPER 08/08/2016)

The page shows the percentage of residents who were completely dependent on staff to complete three key activities of daily living (eating, mobility, and toileting) on the day of the facility’s last inspection as well as the average of the three. This information may be useful in selecting a facility that has residents with needs similar to those of the person entering a facility.

Special Care Needs (Data Source: CMS RUGS 04/20/2015)

Nursing facility residents have various needs requiring different levels of care. The residents with special care needs are the percentage of residents who fall into each of the following five needs groups:

Rehabilitation

Extensive, special care or complex

Impaired cognition

Behavioral problems

Reduced physical function

This information may be useful in selecting a facility that has residents with needs similar to the individual entering a facility.

Magnolia Gardens Convalescent Hospital

Magnolia Gardens Convalescent Hospital in Granada Hills, California 91344 has an Overall Rating of Below Average and a Staffing Rating of Below Average. See ratings on health care quality in nursing homes, why quality matters to you, and how you can help get the care you deserve.

Free and easy-to-use, CalQualityCare.org offers unbiased information and ratings on the quality of California nursing homes and skilled nursing facilities (SNF), along with tips and checklists about how to choose a facility, questions to ask, how to pay for care, and what to do if something goes wrong.

Why be concerned about quality? Even common tasks can go wrong in a facility. When you pay attention to quality, you can better protect yourself. What is quality? Quality care is not always more expensive care, the newest technology, or many tests and treatments. Quality care is safe, effective, patient centered, timely, efficient, and equitable. How does quality affect you? Hear about patients’ experiences where better care would have made a difference. Get the quality you deserve. Take steps to make sure you choose the best facility for you.

When choosing a California nursing home or skilled nursing facility, be sure to understand your particular treatment and the roles that staff play in your care; check your insurance coverage and out of pocket costs; and consider the facility’s location and other features and services.

Physical Therapist Hours per Resident Day

Nursing Wages per Hour

Benefits per Hour (All Employees)

$4.08

$6.32

Staffing

CalQualityCare Rating (Data Source: CA OSHPD FIN 08/12/2016)

CalQualityCare.org provides “Performance Ratings” on important measures of long term care quality. Ratings will help users assess the quality of care available and serve as a guide when comparing and choosing care providers.

The Staffing Performance Rating for nursing homes takes into account three measures: RN staffing levels, total nursing hours, and nursing staff turnover rates. Research shows that adequate staffing levels and lower staff turnover have a positive effect on the health of nursing home residents.

In addition, scores are adjusted to account for varying levels of resident care needs. Facilities should adjust staffing levels to ensure adequate staff to meet the needs of all the residents living in a facility. Because Medicare residents are often in nursing homes immediately following an acute hospital stay, facilities with a high percentage of Medicare days are expected to have higher RN and total staffing hours to meet the greater needs of these residents.

RN staffing levels. RN staffing levels are the average number of hours of RN time available to care for residents per day over a one-year period. The threshold was set at 0.55 RN hours per resident day for facilities with a “low” number of Medicare days and at 3.0 hours for facilities with a “high” number of Medicare days.

Total nursing hours. Total nursing hours includes all RNs, licensed vocational or practical nurses (LVNs), nursing assistants (NAs), and nursing supervisors. The measure shows the average number of hours of nursing staff time available to care for residents per day over a year.

Nursing staff turnover rates. High turnover rates may result in poor quality and coordination of care. Low turnover rates may reflect better management, staff wages and benefits, or other enhanced employment conditions.

The Staffing Performance Rating was based on the combination of RN and total staffing (RNs, LPNs/ LVNs, CNAs) ratings for each facility with equal weights given to the RN and the total staffing ratings. To receive a Superior rating, facilities must meet both RN and total nursing thresholds. In addition to meeting those thresholds, nursing homes with turnover rates greater than 90% during the most recent year received a reduction of one degree.

Medicare Days of Care (Data Source: CA OSHPD FIN 08/12/2016)

To account for differences in resident care needs, nursing homes are divided into two groups: those with a highpercentage of Medicare days (25% or more resident days paid by Medicare) and those with a low percentage of Medicare days (less than 25% of resident days paid by Medicare). This difference is important because Medicare residents tend to have short but care-intensive stays (usually following an acute hospital admission) in nursing homes. Therefore facilities with high Medicare days are expected to need higher nurse staffing hours to meet the greater care needs of residents.

Nursing Staff Turnover (Data Source: CA OSHPD FIN 08/12/2016)

The page shows the percentage of all nurses (not including supervisors) who leave the facility during the year (turnover rate) prior to the day the facility completed its most recent cost report for the Office of Statewide Health Planning and Development (OSHPD). Nursing facilities with low rates of change in nursing staff may provide better quality care than facilities with high turnover rates.

When nursing staff is constantly changing, it may be stressful and disruptive for residents. They have to keep getting used to new people who are not familiar with their routines or special needs.

The lower the nursing staff turnover rate at a nursing facility, the better the quality, continuity, and stability of care. If the turnover rate is high, it could mean there is low employee morale. High employee morale and continuity of care help create a pleasant environment that is more likely to result in high-quality care.

Nursing Hours per Resident Day (Data Source: CA OSHPD FIN 08/12/2016)

Nurse staffing level information is reported as hours per resident day (HPRD). The state of California requires nursing facilities to provide at least 3.2 HPRD of direct nursing care. This measure shows the average number of hours of nursing staff time available to care for residents each day. The total includes all licensed nurses, nursing assistants, and directors of nursing, including part-time, full time, and temporary employees. HPRD is calculated by dividing the total nursing hours worked (excluding time for vacations, sick time, disability, and other paid time off) by the total resident days of care during the year. It does not indicate the number of nurses working at any given time, how well they are organized, or the amount of care given to each resident. Nurse staffing is usually lower on evenings, nights, weekends, and holidays.

Having an adequate number of each type of nurse in a facility is important to provide quality care. It is most important to have a high number of registered nurses, because they have the most education and expertise. The different types of nurses are:

Supervisors and Registered Nurses (RN): Facilities should have at least .75 HPRD (45 minutes) of RN time. Some experts recommend a ratio of one RN or LVN to every 15 residents during the day, one to every 20 residents in the evening, and one to every 30 residents at night. RNs have two to six years of professional education and are trained in the management and care of patients. Only RNs can complete resident assessments and care plans. RNs have the training to give complex nursing care and treatments and provide supervision to other nursing staff. They can evaluate acute and chronic conditions and determine when medical attention is needed.

Licensed Vocational/Practical Nurses (LVN/LPN): Facilities should have at least .55 HPRD (33 minutes) of LVN/LPN time. LVN/LPNs have one year of training. They work with RNs to assess the needs of residents, to develop treatment plans, and to evaluate residents’ responses to care. They often give medications and treatment and may serve as unit supervisors.

Nursing Assistants: Facilities should have 2.8 to 3.2 HPRD (168 to 192 minutes) of nursing assistant time. This is about one nursing assistant for every 6 to 8 residents during the day and evening shifts, and one nursing assistant for every 20 residents on the night shift. Nursing assistants (NAs) provide most of the direct resident care, such as bathing, dressing, toileting, and eating. Some NAs are called orderlies or technicians. They work under the direction of a licensed nurse (RN or LVN). All NAs must become certified (CNAs) within four months of employment. In California, they must take 160 hours of training and pass an exam.

Physical therapist (PT) staffing level information is reported as hours per resident day (HPRD). This measure does not indicate the number of physical therapists working at any given time or the amount of care given to any one resident. The amount of physical therapy given depends on the needs of each resident. All PTs are licensed with the state of California.

Physical therapists help residents improve their movement and manage their pain. PTs test muscle strength, joint flexibility, and the ability to walk or move. PTs often work with doctors, nurses, and occupational therapists (OTs) to create customized plans to improve a resident’s physical function and well-being.

Nursing Wages per Hour (Data Source: CA OSHPD FIN 08/12/2016)

Wages are important for recruiting qualified, experienced staff and keeping them. The more staff who remain, the lower the rate of staff changes at a facility. Facilities with low turnover rates may have higher employee morale than those with frequent changes in staff. High morale could result in better quality care.

Many jobs at nursing facilities pay low wages and sometimes the wages for nursing assistants are below the federal poverty level or less than a living wage. Generally, wages are well below those of hospital employees, workers in the fast food industry, and many other local businesses. Wages may be low because the owners decide to concentrate on increasing profits or because the facility is having financial problems. They may be kept low in facilities with a high percentage of Medi-Cal residents because Medi-Cal reimbursement rates are typically lower than those for all other payers. Low wages can result in staffing shortages and unfilled vacancies.

Magnolia Gardens Convalescent Hospital

Magnolia Gardens Convalescent Hospital in Granada Hills, California 91344 has an Overall Rating of Below Average and a Staffing Rating of Below Average. See ratings on health care quality in nursing homes, why quality matters to you, and how you can help get the care you deserve.

Free and easy-to-use, CalQualityCare.org offers unbiased information and ratings on the quality of California nursing homes and skilled nursing facilities (SNF), along with tips and checklists about how to choose a facility, questions to ask, how to pay for care, and what to do if something goes wrong.

Why be concerned about quality? Even common tasks can go wrong in a facility. When you pay attention to quality, you can better protect yourself. What is quality? Quality care is not always more expensive care, the newest technology, or many tests and treatments. Quality care is safe, effective, patient centered, timely, efficient, and equitable. How does quality affect you? Hear about patients’ experiences where better care would have made a difference. Get the quality you deserve. Take steps to make sure you choose the best facility for you.

When choosing a California nursing home or skilled nursing facility, be sure to understand your particular treatment and the roles that staff play in your care; check your insurance coverage and out of pocket costs; and consider the facility’s location and other features and services.

Tools & Resources: Long Term Care

CalQualityCare Rating

NA

Quality of Facility

CalQualityCare Rating (Data Source: CMS NH COMPARE 06/22/2016)

CalQualityCare.org provides “Performance Ratings” on important measures of long term care quality. Ratings will help users assess the quality of care available and serve as a guide when comparing and choosing care providers.

The Quality of Facility Performance Rating for nursing homes is based on three measures: (1) federal deficiencies, (2) state citations, and (3) substantiated complaint and incident reports. The rating uses the three most recent standard surveys for each nursing home and any complaint investigations during the most recent three-year period. More recent surveys are weighted more heavily than earlier surveys.

Because facilities with more beds and nursing home residents may have more complaints, the number of substantiated complaints and incidents are standardized by the total number of beds.

See Details

Deficiencies and Citations

Deficiencies and Citations

Deficiencies are given for violations of federal minimum standards for care and citations are given for state violations. The California Licensing and Certification Program (L&C) surveys nursing facilities every 12 to 15 months to ensure that minimum state and federal standards of care and safety are being met. The surveyors may use the medical records of residents, interviews with residents and staff, and observations of care to decide if a facility meets the minimum standards. When a surveyor finds that a standard is not met, the nursing facility receives a deficiency or citation. Nursing facilities may also get a deficiency or citation in response to a substantiated complaint.

State and federal standards for quality of care and safety are grouped into nine types. When reviewing the deficiencies and citations, pay attention to how many deficiencies and citations a facility received, whether a facility received more than one for the same type of violation (repeat deficiencies), and whether a facility has a high number of serious violations. Deficiencies and citations in the quality of care, abuse, and nutrition groups may be the most serious.

See Details (Data Source: CMS NH COMPARE 06/22/2016)

Quality of care: Failure to care for medical conditions and nursing needs appropriately and on a timely basis. These standards also include whether there is a sufficient number of nurses to care for each resident. They may identify when a facility failed to help residents with the activities of daily living or provide necessary care or treatment.

Mistreatment: Failure to prevent verbal, sexual, physical and mental abuse, the use of physical restraints, corporal punishment, or involuntary seclusion. This type of deficiency may also be given if a facility hires staff found guilty of abuse, neglect or mistreatment.

Resident assessment: Failure to properly assess each resident’s care needs, and failure to develop, follow, and evaluate a care plan for each resident. Also, failure to hire qualified and trained nursing staff.

Resident rights: Failure to respect, recognize, and uphold the rights of residents.

Environment: Failure to maintain the resident environment in a manner that protects the health and safety of its residents, personnel, and the public.

Nutrition: Failure to meet each resident’s nutritional needs and special dietary requirements or to properly prepare, serve, and store meals.

Pharmacy: Failure to comply with pharmacy procedures for properly dispensing and storing medications. These standards are designed to make sure residents get the right medication at the right time.

Administration: Failure to provide adequate administration and management. By law, a facility must be run in an efficient and effective manner that enables it to use its resources to attain and maintain the highest level of physical, mental and psychosocial well-being for each resident.

Life safety: Failure to create and maintain a safe environment for residents, and meet state and federal building inspection and fire codes were not met.

Deficiency Severity

Deficiency Severity (Data Source: CMS NH COMPARE 06/22/2016)

At the time of a facility survey, the surveyors use the scope and severity scales to assess the level of harm a deficiency has caused a resident and the extent of the harm within the facility. An isolated incident that caused no actual harm, for example, would result in a deficiency that carries a less serious penalty than a violation that is widespread throughout the facility and that has caused actual harm to the residents. The type of enforcement action taken against a facility depends upon the seriousness of the deficiency based upon the scope and severity scales.

The deficiency severity scale has four levels:

Death or Serious Injury: Immediate jeopardy or serious harm to resident health and safety, or death occurred

Actual Harm: Actual harm that is not immediate jeopardy

Minimal Discomfort: No actual harm with potential for more than minimal harm that is not immediate jeopardy

No Harm, with the Potential for Minimal Harm: No actual harm with potential for minimal harm

Deficiency Scope

Deficiency Scope (Data Source: CMS NH COMPARE 06/22/2016)

At the time of a facility survey, the surveyors use the scope and severity scales to assess the level of harm a deficiency has caused a resident and the extent of the harm within the facility. An isolated incident that caused no actual harm, for example, would result in a deficiency that carries a less serious penalty than a violation that is widespread throughout the facility and that has caused actual harm to the residents. The type of enforcement action taken against a facility depends upon the seriousness of the deficiency based upon the scope and severity scales.

The deficiency scope scale has three levels:

Widespread: When the problems causing the deficiencies are pervasive in the facility and/or represent systemic failure that affected or has the potential to affect a large number or all of the facility’s residents. Widespread scope refers to the entire facility population, not a subset of residents or one unit of a facility.

Pattern: When more than a very limited number of residents are affected, and/or more than a very limited number of staff are involved, and/or the situation has occurred in several locations, and/or the same resident(s) have been affected by repeated occurrences of the same deficient practice.

Isolated: When one or a very limited number of residents are affected and/or one or a very limited number of staff are involved, and/or the situation has occurred only occasionally or in a very limited number of locations.

Complaints

Complaints (Data Source: ASPEN 08/08/2016)

A complaint is a formal grievance against a facility that is filed with and investigated by the California Licensing and Certification (L&C) Program, which is responsible for monitoring nursing facility quality. It is filed when someone has an objection to treatment or safety. Complaints may be considered an indication of quality because, to some extent, they show the degree of consumer satisfaction or dissatisfaction with a nursing facility. Complaints are grouped into eight categories.

Complaints may also be filed with a local ombudsman. If the ombudsman investigates and finds a serious problem, she or he will inform L&C and ask them to investigate. Only the L&C agency may issue deficiencies or citations for violations of the federal and state requirements.

After complaints are investigated by L&C, they are deemed either substantiated (if the inspector found the claim to be true), or unsubstantiated (if there was no proof to support the complaint). If a complaint is substantiated, a deficiency or citation may be given to the facility.

State Violations and Fines

Facility Enforcement Actions

Federal Penalties and Fines (Data Source: CMS NH COMPARE 06/22/2016)

When a facility has been found responsible for serious harm or endangerment of a resident, the California Department of Public Health, Licensing and Certification Division (L&C) can recommend a variety of federal actions, in addition to state sanctions, depending upon the seriousness of a violation. The federal remedies include directed plans of correction, directed in-service trainings, state monitoring, denial of payment for new admissions, federal civil monetary penalties, appointment of a temporary manager, and termination of Medicare or Medicaid payments. Over 80% of California nursing homes participate in Medicare and/or the Medicaid programs and are subject to federal sanctions if they violate the laws.

This section displays the federal and state enforcement actions that a nursing home received for a serious deficiency or if the nursing home failed to correct a deficiency for a long period of time. The California average for federal and state penalties is a little less than one per facility per year. The majority of facilities have few or none. A nursing home with numerous citations suggests real problems.

The two most common federal sanctions are fines and payment denials.

Fines: Fines are imposed once per deficiency or each day until the nursing home corrects the deficiency.

Denials of Payment for New Admission: The government stops Medicare or Medicaid payments to the nursing home for new residents until the facility corrects the deficiency.

State Violations and Fines (Data Source: ELMS 07/01/2016)

The page shows the total number of citations (three types) and the total amount of fines issued over the past three years by the California Department of Public Health (CDPH).

Resident Death: The Class AA citation is the most serious. A resident has died in such a way that the CDPH decided that the facility was responsible. The fines range from $25,000 to $100,000.

Resident Danger: The Class A citation is issued when a resident is in immediate danger of death or serious bodily harm. The fines range from $2,000 to $20,000.

Resident Care: The Class B citation is issued when a violation presents a direct or immediate risk to the resident’s health, safety, or security. This can include emotional and financial elements. The fines range from $100 to $1,000.

Staffing: The AN (or AP NHPPD) citation is an Administrative Penalty for failure to provide each resident a minimum of 3.2 hours of skilled nursing care per day. This citation carries fines of $15,000 for failure to meet the requirement for 5 to 49% of the audited days and $30,000 for failure to meet the requirement for more than 49% of the audited days.

Improper Disclosure of Health Information: This category includes the Failure to Report (FTR [or FB, FP]) and Willful Material Falsification or Willful Material Omission (WMF or WMO) citations. The Failure to Reportcitation is issued when unlawful or unauthorized access to, use, or disclosure of, a resident’s medical information is not reported to the affected resident or the resident’s representative, and/or to CDPH. Willful Material Falsification or Willful Material Omission in the health record of a resident carries fines from $2,000 to $20,000 per citation.

Magnolia Gardens Convalescent Hospital

Magnolia Gardens Convalescent Hospital in Granada Hills, California 91344 has an Overall Rating of Below Average and a Staffing Rating of Below Average. See ratings on health care quality in nursing homes, why quality matters to you, and how you can help get the care you deserve.

Free and easy-to-use, CalQualityCare.org offers unbiased information and ratings on the quality of California nursing homes and skilled nursing facilities (SNF), along with tips and checklists about how to choose a facility, questions to ask, how to pay for care, and what to do if something goes wrong.

Why be concerned about quality? Even common tasks can go wrong in a facility. When you pay attention to quality, you can better protect yourself. What is quality? Quality care is not always more expensive care, the newest technology, or many tests and treatments. Quality care is safe, effective, patient centered, timely, efficient, and equitable. How does quality affect you? Hear about patients’ experiences where better care would have made a difference. Get the quality you deserve. Take steps to make sure you choose the best facility for you.

When choosing a California nursing home or skilled nursing facility, be sure to understand your particular treatment and the roles that staff play in your care; check your insurance coverage and out of pocket costs; and consider the facility’s location and other features and services.

Tools & Resources: Long Term Care

CalQualityCare Rating

NA

Quality of Care

CalQualityCare Rating (Data Source: CMS NH COMPARE 06/22/2016)

CalQualityCare.org provides “Performance Ratings” on important measures of long term care quality. Ratings will help users assess the quality of care available and serve as a guide when comparing and choosing care providers.

The Quality of Care Performance Rating for nursing homes is based on the system used by the federal government (Centers for Medicare & Medicaid Services). The quality of care rating is based on nine measures that show how well a nursing home cares for residents’ needs. The rating is based on seven measures for long-stay residents (101 days or more) and two measures for short-stay residents (100 days or fewer).

Once the summary Quality of Care score is computed for each facility, a rating is assigned based on the nationwide distribution of the scores:

Superior: Facility scored 616 or more points (16%)

Above Average: Facility scored 508–615 points (31%)

Average: Facility scored 436–507 points (24%)

Below Average: Facility scored 356–435 points (18%)

Poor: Facility scored 355 or fewer points (11%)

The Quality of Care section displays 11 measures: eight for long-stay residents and three for short-stay residents, as discussed below. The long-stay and short-stay antipsychotic use measures are not included in the Quality of Care rating.

Antianxiety or Hypnotic Medication Use

Long-Stay Residents

The page shows the percentage of residents who have had a loss of physical functioning or ability to carry out activities including eating, toileting, transferring, or mobility. Most residents are at risk for physical decline and loss of physical function in carrying out activities of daily living because of chronic illnesses, physical factors (such as loss of endurance, muscle tone, or balance), or cognitive impairment. Residents who are able should be strongly encouraged to be out of bed as much as possible, and they should receive assistance with activity, exercise, and walking. All residents are candidates for nursing rehabilitation services to improve and maintain physical functioning.

It’s important that nursing homes maintain a resident’s independence in moving as much as possible. If a resident’s ability to move decreases, the resident is at greater risk for hospitalization, pressure ulcers, musculoskeletal disorders, pneumonia, circulatory problems, constipation, and reduced quality of life. Residents who have a decline in their ability to move independently also require more staff time than those who are more independent. This page show the percentage of residents who have had a decline in their ability to move independently.

Residents who are confined to bed or have difficulty moving around are at a greater risk of developing pressure ulcers. The page shows the percentage of such residents who have one or more pressure ulcers or sores. A pressure ulcer (or bed sore) is an injury caused by constant pressure to the skin and muscle. Pressure ulcers may cause pain, infection, decreased social interaction, a decline in self-care activities, and a longer stay in the nursing facility. Residents may die from complications directly related to severe pressure ulcers. If residents are turned or repositioned every two or three hours, eat adequate amounts of food and liquids, and are kept clean and dry, most pressure ulcers are preventable. The chances of developing pressure ulcers may also be reduced through the use of pressure reducing devices like air pads, gel flotation pads or special padding on beds and wheelchairs. These devices do not replace moving (repositioning) or turning residents frequently.

Use of Catheters (Data Source: CMS NH COMPARE 06/22/2016)

The page shows the percentage of residents who have/had a catheter inserted and left in place. A catheter is a tube that is inserted into the bladder to manage urination. A catheter should only be used when it is medically necessary and not for the convenience of the nursing home staff. Residents may need a lot of help to get to the toilet, or they may have to go frequently. Using a catheter may result in complications, like urinary tract or blood infections, physical injury, skin problems, bladder stones, or blood in the urine.

Use of Restraints (Data Source: CMS NH COMPARE 06/22/2016)

The page shows the percentage of residents who are prevented or restricted from moving through the use of a physical device or other method that inhibits freedom of movement. Restraints include hand mitts, soft ties or vests, chairs with lap trays, bed side rails, belts, and wheelchair foot pedals where residents are unable to release the restraint. By law, physical restraints can not be used unless they have been ordered by a physician. Residents have a right to be free from restraints. Restraints should not be used for the convenience of staff. Restraints do not necessarily provide security or safety to residents. Restraints may have negative effects and risks that may far outweigh any possible benefits. The risks include: development of pressure sores, loss of mobility, agitation, falls, loss of dignity, social isolation, and possibly death. If restraints are used, they must be removed frequently (about every two hours) to allow the resident to move. Frequent exercise and repositioning are very important to the health and safety of residents, with or without restraints.

Urinary Tract Infections (Data Source: CMS NH COMPARE 06/22/2016)

The page shows the percentage of residents who had infections in their urinary tracts during the 30 days before the most recent assessment. A urinary tract infection begins in the urethra — the tube that passes urine from the bladder to the outside of the body — and, if left untreated, can spread to the bladder or even the kidneys. The infection can cause intense pain and fever. Most urinary tract infections can be prevented by encouraging residents to empty the bladder regularly and to drink enough fluids. Facility staff should also make sure that residents have good hygiene. Finding out the cause and getting early treatment of such an infection can prevent it from spreading and becoming more serious or causing complications.

Moderate to Severe Pain (Data Source: CMS NH COMPARE 06/22/2016)

The page shows the percentage of residents with moderate to severe pain. Staff should check residents regularly for pain, find the cause, and try make the resident more comfortable. If pain is not treated, a resident may not be able to perform daily routines, may become depressed, or have an overall poor quality of life. This percentage may include some residents who are getting or have been prescribed treatment for their pain, but who refuse pain medicines or choose to take less. Some residents may choose to accept a certain level of pain so they can stay more alert.

One or More Falls with Injury (Data Source: CMS NH COMPARE 06/22/2016)

The page shows the percentage of residents that experienced at least one fall resulting in an injury in the last year. One-third of falls among nursing home residents results in an injury such as bone fractures, joint dislocations, closed head injuries, subdural hematoma, or altered consciousness. Facilities should actively strive to help prevent falls and fall-related injuries.

Antipsychotic Use (Data Source: CMS NH COMPARE 06/22/2016)

The page shows the percentage of residents that receive antipsychotic medication. While an important treatment for patients with certain mental health conditions, antipsychotic medications have serious side effects and are associated with an increased risk of death when used in elderly patients with dementia. Interventions that do not involve medications, such as increased staffing, many and varied activities, and consistent staff assignment, can work and should be tried first. Use of antipsychotics should be carefully monitored. Consumers should ask about a nursing home’s approach to managing behavior. The federal Centers for Medicare & Medicaid Services (CMS) is developing a national action plan to improve behavioral health management and to safeguard nursing home residents from unnecessary antipsychotic drug use.

The page shows the percentage of residents that receive antianxiety or hypnotic medication. Nursing Homes may appropriately give antianxiety or hypnotic medications for a limited period of time to treat acute symptoms, but high rates of use of these medications may point to insufficient assessment of residents and over use of pharmacological agents. Consumers should ask nursing homes about their approach to managing behavior. Interventions that don’t require medications, like higher staffing ratios, many and varied activities, and consistent assignment of nursing staff, have been shown to be successful at lowering the use of psychotropic medications in many cases.

Improvements in Function (higher is better)

Emergency Department Visit

Rehospitalized After Nursing Home Admission

Successful Discharge (higher is better)

Antipsychotic Use

3%

(lower is better)

1%

(lower is better)

Short-Stay Residents

The short-stay quality measures apply to residents in a facility 100 or fewer days.

Pressure Sores (Data Source: CMS NH COMPARE 06/22/2016)

The page shows the percentage of short-stay residents recently admitted to the nursing home following a hospital stay who have developed pressure sores, or who had pressure sores that did not get better between their 5-day and 14-day assessments in the nursing home. Residents who are confined to bed or have difficulty moving around are at a greater risk of developing pressure ulcers. A pressure ulcer (or bed sore) is an injury caused by constant pressure to the skin and muscle. Pressure ulcers may cause pain, infection, decreased social interaction, a decline in self-care activities, and a longer stay in the nursing facility. Residents may die from complications directly related to severe pressure ulcers. If residents are turned or repositioned every two or three hours, eat adequate amounts of food and liquids, and are kept clean and dry, most pressure ulcers are preventable. The chances of developing pressure ulcers may also be reduced through the use of pressure reducing devices like air pads, gel flotation pads or special padding on beds and wheelchairs. These devices do not replace moving (repositioning) or turning residents frequently.

Moderate to Severe Pain (Data Source: CMS NH COMPARE 06/22/2016)

The page shows the percentage of short-stay residents experiencing moderate to severe pain. Staff should check residents regularly for pain, find the cause, and try make the resident more comfortable. If pain is not treated, a resident may not be able to perform daily routines, may become depressed, or have an overall poor quality of life. This percentage may include some residents who are getting or have been prescribed treatment for their pain, but who refuse pain medicines or choose to take less. Some residents may choose to accept a certain level of pain so they can stay more alert.

Short-stay residents frequently have limitations in their physical functioning because of illness, hospitalization, or surgery. Nursing homes help residents improve physical functioning. The page shows the percentage of short-stay residents who improved their independence during their stay in these functions (i.e., transfer: self-performance; locomotion on unit: self-performance; walk in corridor: self-performance).

Emergency Department Visit (Data Source: CMS NH COMPARE 06/22/2016)

Emergency Departments provide necessary care for many residents of nursing homes. However, if a nursing home regularly sends many residents to the emergency room, it may indicate that the nursing home isn’t properly assessing or taking care of its residents to prevent the development of conditions that require emergency treatment. The page shows the percentage of short-stay residents who had an emergency room visit.

Nursing homes help residents recuperate from a hospital stay and avoid going back to the hospital. Sometimes it’s necessary for a resident to return to the hospital. However, if a nursing home sends many residents back to the hospital, it may indicate that the nursing home isn’t properly assessing or taking care of its residents who are admitted to the nursing home from a hospital. The page shows the percentage of short-stay residents who were rehospitalized.

High rates of successful discharge, or a resident remaining in the community for at least a month, indicate that the nursing home is restoring a resident’s function so that she or he may successfully return to the community. The page shows the percentage of short-stay residents who were successfully discharge to the community.

Antipsychotic Use (Data Source: CMS NH COMPARE 06/22/2016)

The page shows the percentage of short-stay residents being treated with antipsychotic medications. While an important treatment for patients with certain mental health conditions, antipsychotic medications have serious side effects and are associated with an increased risk of death when used in elderly patients with dementia. Interventions that do not involve medications, such as increased staffing, many and varied activities, and consistent staff assignment, can work and should be tried first. Use of antipsychotics should be carefully monitored. Consumers should ask about a nursing home’s approach to managing behavior. The federal Centers for Medicare & Medicaid Services (CMS) is developing a national action plan to improve behavioral health management and to safeguard nursing home residents from unnecessary antipsychotic drug use.

Magnolia Gardens Convalescent Hospital

Magnolia Gardens Convalescent Hospital in Granada Hills, California 91344 has an Overall Rating of Below Average and a Staffing Rating of Below Average. See ratings on health care quality in nursing homes, why quality matters to you, and how you can help get the care you deserve.

Free and easy-to-use, CalQualityCare.org offers unbiased information and ratings on the quality of California nursing homes and skilled nursing facilities (SNF), along with tips and checklists about how to choose a facility, questions to ask, how to pay for care, and what to do if something goes wrong.

Why be concerned about quality? Even common tasks can go wrong in a facility. When you pay attention to quality, you can better protect yourself. What is quality? Quality care is not always more expensive care, the newest technology, or many tests and treatments. Quality care is safe, effective, patient centered, timely, efficient, and equitable. How does quality affect you? Hear about patients’ experiences where better care would have made a difference. Get the quality you deserve. Take steps to make sure you choose the best facility for you.

When choosing a California nursing home or skilled nursing facility, be sure to understand your particular treatment and the roles that staff play in your care; check your insurance coverage and out of pocket costs; and consider the facility’s location and other features and services.

Average Total Expenditures per Resident Day (Data Source: CA OSHPD FIN 08/12/2016)

The page shows the percentage for each category of the total facility expense. The category expense is divided by the total number of resident days which is divided by the total expenditure. This allows for a fair comparison across facilities. Expenditures per resident day is not available for hospital-based facilities as the cost reporting data for long term care business for expenses are not separated from the general hospital expenses.

Capital expenses: Includes expenses for leases and rental, interest and depreciation include the expenses for use of the building and equipment for the facility including leases and the rental of property related to the building, equipment, and improvements.

Nursing facilities are reimbursed differently for similar services depending on each payer. Reimbursement rates affect quality of care. California sets Medi-Cal reimbursement rates and keeps them low. This may result in low staffing levels in nursing facilities with mostly Medi-Cal residents.

Medicare reimbursement rates are much higher than Medi-Cal rates. Medicare rates are set by the federal government based on a system that takes into account the care needs of residents. Therefore, staffing levels and quality of care are generally better at nursing facilities with a high percentage of Medicare residents.

Self-pay rates are not regulated. Nursing facilities may charge their self-pay residents as much as they want to. Facilities that accept only self-pay residents may charge higher rates and may have more money to spend on staff and other improvements.

Managed care plans negotiate with facilities for rates they are willing to pay.

This reflects the percentage of the facility’s total days of care that is paid by each payer. It is calculated by dividing the number of resident days paid for by each payer by the total number of resident days. “Other” includes private health insurance, managed care plans, and other payers.

Net Operating Income or Loss (Data Source: CA OSHPD FIN 08/12/2016)

This is the total amount of money earned from health care operations plus non-operating revenue — after nonoperating expenses have been deducted — excluding taxes and extraordinary items. If it is a positive amount, the facility made a profit. If it is a negative amount, the facility is operating at a loss.

Facilities operating at a loss may have quality of care problems. Conversely, for-profit facilities with very high profits may be taking profits they could be using to pay for resident care. For-profit facilities may pay the profits to owners or stockholders, while nonprofit facilities must reinvest profits in the facility or related activities.

Operating Margin (Data Source: CA OSHPD FIN 08/12/2016)

The operating margin is net income divided by health care operating revenue. This is another way of showing the percentage of profits or losses in a facility. Negative numbers indicate a net loss for the reporting period. Values shown for different agencies can range widely. Profit margins over 9% in for-profit facilities may be excessive and could result in poor quality of care.